Cardiopulmonary Resuscitation Policy

Cardiopulmonary Resuscitation Policy

Policy Title: Executive Summary: Cardiopulmonary Resuscitation Policy The provision of an effective resuscitation service for patients, who collapse in cardiopulmonary arrest, is a priority within every Trust. The adequate performance of such a service has wide ranging implications with respect to training, standards of care, risk management and clinical governance Supersedes: Cardiopulmonary Resuscitation Policy Version 6.0 Description of Amendment(s): This policy will impact on: Clinical practices Sections 2.7/4.4, updated information relating to Ward Senior Sisters/Department Managers responsibility Sections 5.9/5.10, updated information relating to checking requirements of resuscitation equipment Sections 5.13/13.1.4, inclusion of requirement to monitor waveform capnography Section 16.1, timescale for Policy review extended Where appropriate, reference to other ECNHST Policies, and hyperlinks/references/appendices have been updated Financial Implications: Recurring costs of udnacpr Forms and Patient Information Leaflets Policy Area: Trust Wide Document ECT002537 Reference: Version Number: 7.0 Effective Date: August 2016 Issued By: Medical Director Review Date: August 2019 Author: Resuscitation Officer Impact Assessment Date: Consultation: Legal Services Equality/Engagement Manager APPROVAL RECORD Committees / Group Resuscitation Committee Risk Management Sub-committee June 2016 Date May 2016 July 2016 Approval Committee: Resuscitation Committee June 2016 Ratified by Committee/ Executive Director: Received for information: Risk Management Sub-committee 13 July 2016 Clinical Directors August 2016 Heads of Nursing August 2016 2

SECTION CONTENTS PAGE 1.0 Policy Statement 4 2.0 Organisational Responsibilities 4 3.0 Emergency Response Standard Operational Procedure 8 4.0 Resuscitation Training 8 5.0 Process for Ensuring the Continual Availability of Resuscitation Equipment 9 6.0 Procurement 10 7.0 Defibrillation 10 8.0 Manual Handling 11 9.0 Cross Infection 11 10.0 Anaphylaxis 11 11.0 Prevention of Cardiac Arrest the deteriorating patient 11 12.0 Decisions Relating to Cardiopulmonary Resuscitation 12 13.0 Patient Transfer and Post Resuscitation Care 12 14.0 Implementation and Access to this Policy 13 15.0 Measuring Performance and Audit Completion 13 16.0 Cardiopulmonary Policy Review 13 17.0 Equality and Diversity 13 18.0 References 13 Appendix 1 Cardiac Arrest Team Activity Proforma 15 Appendix 2 Cardiac Arrest Team Members 17 Appendix 3 Macclesfield District General Hospital (MDGH): Checklist for Adult Resuscitation Equipment 18 Appendix 4 Order Codes for MDGH Checklist for Adult Resuscitation Equipment 20 Appendix 5 List of Drugs Contained within the Adult Red Emergency Drug Boxes 22 Appendix 6 Instructions for the Daily Check of the Philips XL Defibrillators 23 Appendix 7 Equality Analysis (Impact Assessment) 24 3

1.0 Policy Statement East Cheshire NHS Trust (ECNHST) has a duty of care to provide an effective resuscitation service for patients who suffer cardiopulmonary arrest. To achieve this standard all relevant staff will be trained appropriately and regularly updated to a level compatible with their expected degree of competence. The purpose of this policy is to provide direction and guidance for the planning and implementation of a high-quality and robust resuscitation service to the organisation. The strategy for resuscitation incorporates the current Resuscitation Council (UK) guidelines which can be found at www.resus.org.uk. This policy fully supports the recommendations for quality standards for cardiopulmonary resuscitation practice and training published by the Resuscitation Council (UK) (2013). This policy is applicable to all ECNHST staff. 2.0 Organisational Responsibilities 2.1 The Chief Executive Has ultimate responsibility for the implementation and monitoring of the policies in use in the Trust. This responsibility may be delegated to an appropriate colleague. 2.2 All Directors/Heads of Service All Directors/Heads of Service are responsible for the implementation of this policy. 2.3 The Resuscitation Committee The Resuscitation Committee will meet quarterly and a nominated Consultant from a relevant specialty will chair the Committee. It will consist of core members, together with specialist advisors and clinical representatives from Anaesthetics, Emergency Department, Medicine, Cardiology, Surgery, Paediatrics, Nursing staff, Pharmacy, Medical Engineering, Clinical Risk, Specialist Palliative Care, the Community and Lay Representation. The Resuscitation Committee is responsible for: Developing and overseeing the implementation of operational policies governing resuscitation practice and training Advising on the composition of the Resuscitation Teams and their roles Providing guidance to the provision of appropriate equipment throughout the Trust both for the resuscitation of patients and for training purposes Ensuring that the guidelines for the resuscitation of patients who suffer cardiopulmonary arrest are implemented effectively Ensuring that cardiac arrests are recorded and audited using a standard Trust template Reporting to the Risk Management Sub-committee and providing a periodic report on progress Approving the Cardiopulmonary Resuscitation Policy, the Unified Do Not Attempt Cardiopulmonary Resuscitation Adult Policy and the Paediatric Do Not Attempt Cardiopulmonary Resuscitation Policy prior to ratification by the Risk Management Subcommittee 4

2.4 The Resuscitation Officer The Resuscitation Officer is a full member of the Resuscitation Committee and is responsible for: Monitoring compliance with the Cardiopulmonary Resuscitation Policy Monitoring compliance with the Unified Do Not Attempt Cardiopulmonary Resuscitation Adult Policy and the Paediatric Do Not Attempt Cardiopulmonary Resuscitation Policy Coordinating the teaching and training of staff in resuscitation techniques Ensuring that accurate and up-to-date training records are retained for Trust employees who have received resuscitation training Ensuring that the documentation of all cardiopulmonary arrests is carried out utilising the standard Trust Cardiac Arrest Team Activity Proforma (see appendix 1) Monitoring the number of cardiac arrest calls per month to look for evidence of trends Conducting periodic audit of cardiac arrest outcome Auditing compliance with the daily checking process of resuscitation equipment throughout the Trust Attending cardiopulmonary resuscitation attempts when available, in an advisory and monitoring role Ensuring continued self-education in resuscitation skills and protocols 2.5 The Resuscitation Team ECNHST has three Resuscitation Teams, i.e. an Adult Resuscitation Team, Paediatric Resuscitation Team and Neonatal Resuscitation Team; the composite of these teams is detailed in appendix 2. All three teams are available 24 hours a day to respond to medical emergencies occurring within the boundaries of Macclesfield District General Hospital, i.e. the Acute setting. The Resuscitation Team is responsible for: Attending all cardiopulmonary arrests in response to a cardiac arrest call within their given remit, for example, the Adult Resuscitation Team to attend an adult cardiac arrest Ensuring that all aspects of cardiopulmonary arrest management follow the current guidelines of the Resuscitation Council (UK) and the European Resuscitation Council Identifying the Resuscitation Team Leader Ensuring that, as an individual, they are appropriately trained and maintain a level of competence appropriate to their role Responding to the test call for the cardiac arrest pager as soon as practically possible by phoning 2222 and confirming they received the call 2.6 The Resuscitation Team Leader 2.6.1 The Resuscitation Team Leader should be clearly identified once the Resuscitation Team arrive. This person will assume overall responsibility for the patient during the incident: For adult resuscitation, this will be the role of the Medical Senior House Officer (SHO) or Registrar who should be qualified in Advanced Life Support (ALS) and hold a current valid Resuscitation Council (UK) or European Resuscitation Council ALS certificate. If the Medical SHO or Registrar on the team does not hold a current ALS certificate the position of Team Leader will be delegated to another member of the arrest team who does hold a current ALS certificate For paediatric resuscitation the Team Leader should normally be a Paediatrician with Advanced Paediatric Life Support (APLS) or Paediatric Advanced Life Support (PALS), although in the initial stages resuscitation should be commenced even if a (APLS/PALS) trained Team Leader is not available For neonatal resuscitation the Team Leader should be the Neonatal Middle Grade doctor, or Advanced Neonatal Nurse Practitioner (ANNP), depending on the bleep holder at the time 5

2.6.2 The Team Leader has a specific role directing the resuscitation attempt, ensuring it continues in a coordinated manner and directing the overall management of the patient. The Team Leader will be responsible for patient assessment throughout, ensuring that: Adequate Basic Life Support is being performed Adequate airway management is being performed Defibrillation (if appropriate) is delivered swiftly and safely Tasks are designated to the other team members who have the most appropriate skills Current guidelines are followed where possible 2.6.3 If resuscitation is successful, it will be the Team Leader s responsibility to communicate with those responsible for the further care of the patient. 2.6.4 It is the Team Leader s responsibility to make the final decision to stop the resuscitation attempt after all appropriate avenues of treatment have been exhausted. This should be done after discussion with all members of the team, including relatives where appropriate. 2.6.5 It is the Team Leader s responsibility to ensure that all necessary documentation is accurately completed as soon as possible after the resuscitation attempt. Included in this is the Cardiac Arrest Team Activity Proforma (see appendix 1) which, once completed, should be sent to the Resuscitation Officer. 2.6.6 During a resuscitation attempt a member of staff should be allocated to liaise closely with the relatives who may wish to be present. For the purpose of this document the term relative must be interpreted as next of kin and/or carer, and is restricted to adults only. After a resuscitation attempt the Team Leader should speak to the patient s relatives in an appropriate environment. 2.6.7 The Team Leader should consider the location, safety issues, and individual response to the situation when relatives wish to be present. At no one time should the presence of relatives impair the safety of the Resuscitation Team or the patient. The final decision will lie with the Team Leader. 2.6.8 Guidance on how to deal with those family members who may wish to witness a relative undergoing cardiopulmonary resuscitation is available through the Royal College of Nursing (RCN) document Witnessing Resuscitation (RCN 2002). ECNHST supports the RCN view that wherever possible, witnessed resuscitation should be allowed if that is the wish of the relatives and family members. 2.7 Ward Senior Sisters/Department Managers Ward Senior Sisters/Department Managers are responsible for: Ensuring that all new clinical staff receive adult Basic Life Support training as part of their induction and that all new staff, clinical and non-clinical, know how to initiate a cardiac arrest call using the universal number 2222 for emergencies occurring within the boundaries of Macclesfield District General Hospital and 999 for the Ambulance Service for emergencies occurring within the Community setting Ensuring all staff who are booked on resuscitation training events are released from their duties so they may attend Ensuring all clinical staff receive resuscitation training appropriate to their individual needs as per ECNHST role specific training needs analysis 6

Monitoring staff attendance for resuscitation training events Ensuring there are systems in place to check the resuscitation equipment daily against the ECNHST Acute setting standard checklist and that actions are taken to repair or replace faulty, missing or out-of-date stock. Please refer to appendix 3 for the standard Adult Resuscitation Equipment Checklist Where applicable, maintaining adequate supply of the Cardiac Arrest Team Activity Proforma (see appendix 1) in their designated area 2.8 All Clinical Staff It is each individual s responsibility to: Adhere to the ECNHST Cardiopulmonary Resuscitation Policy Be accountable for his or her own actions and to ensure that they are competent to initiate cardiopulmonary resuscitation, unless there is a prior documented decision not to resuscitate the patient Attend resuscitation training events as per their line managers instruction Ensure they are familiar with the resuscitation equipment in the area in which they work to a level expected of their specific role 2.9 Ancillary/Support Staff including Clerical, Secretarial etc. Are responsible for knowing how to initiate a cardiac arrest call using the universal number 2222 for emergencies occurring within the boundaries of Macclesfield District General Hospital and 999 for the Ambulance Service for emergencies occurring within the Community setting; please refer to section 3.0 of this Policy for details. 2.10 Resuscitation of Paediatric Patients 2.10.1 Special conditions apply when resuscitating children both in the aetiology of cardiopulmonary arrest and in the techniques of resuscitation and it is imperative that experienced personnel, who are aware of these special needs, are present at the resuscitation attempt. Consequently, the Trust has a Paediatric Resuscitation Team (see appendix 2 for the composite of this team). The Paediatric Consultant on call will also be informed by switchboard that a paediatric arrest call has been made. 2.10.2 Ethical issues are especially difficult when resuscitating a child and consideration will be given to the care of relatives who may be present. Wherever possible a member of staff will be delegated to stay with relatives and liaise with the team on their behalf. 2.11 Neonatal Emergencies 2.11.1 The Neonatal Resuscitation Team consists of the Neonatal Middle Grade doctor or ANNP (depending on the bleep holder at the time) and Neonatal SHO. 2.11.2 In the event of a Paediatric Consultant being required, the Neonatal Middle Grade doctor/annp will request separately (via a 2222 call) that the on call Paediatric Consultant needs to be in attendance. 2.11.3 The Neonatal Resuscitation Team will be available specifically to deal with newborn and neonatal emergencies in Theatres, the Delivery Suite, Postnatal Ward, the Neonatal Unit (NNU) and if necessary in the Emergency Department. 7

2.11.4 For the process and detail of Neonatal Resuscitation please refer to the ECNHST Newborn Life Support guidelines (the current version can be found under Maternity in the Clinical Guidelines section on the Trust Infonet). 3.0 Emergency Response Standard Operational Procedure 3.1 Acute Setting, i.e. within the boundaries of Macclesfield District General Hospital: 3.1.1 When an adult or child collapses with suspected cardiopulmonary arrest staff should immediately call the Resuscitation Team by dialling the universal number 2222. The precise location of the patient must be communicated promptly and clearly to the switchboard operator: For adult patients state adult cardiac arrest and specify precise location For paediatric patients state paediatric cardiac arrest and specify precise location For neonates state neonatal cardiac arrest and specify precise location 3.1.2 Upon receipt of the cardiopulmonary arrest call the switchboard operator will immediately relay this to the relevant Resuscitation Team on call. Members of the team will attend without delay to the specific location and will stay until relieved of this duty by the Resuscitation Team Leader. 3.1.3 The Resuscitation Team will respond in all cases except where a specific, current Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form has been completed, and is in the front of the patient s medical records. Full resuscitation attempts will be instigated without hesitation unless a doctor or qualified nurse who knows the patient and knows that a valid DNACPR form has been completed declares this, or until this documentation is produced. 3.1.4 Medical staff who cannot attend must immediately inform switchboard that they cannot attend and if possible should arrange for another approved member of their specialty to attend on their behalf. 3.1.5 Cardiopulmonary arrest calls from outside the main buildings of Macclesfield District General Hospital - i.e. hospital drive or grounds - and from the Millbrook Unit will still be attended to by the Resuscitation Team. In addition a 999 call will be made simultaneously by switchboard to ensure the patient is transferred by Ambulance to the appropriate department. 3.2 Community Setting: 3.2.1 When an adult or child collapses, due to a medical emergency, an Ambulance must be called immediately by dialling 999. 3.2.2 In the circumstances whereby a doctor is on the premises it is an expectation that they will attend to the immediate medical needs of the patient. 4.0 Resuscitation Training 4.1 The requirement to attend training in resuscitation techniques is dependent on the role, responsibilities and clinical function of the individual post-holder. Please therefore refer to the ECNHST Training Needs Analysis for information on training requirements. 8

4.2 For training purposes ECNHST adopts the national resuscitation guidelines, as published periodically by the Resuscitation Council (UK), as its basis for treatment of patients in cardiac arrest. Treatment algorithms displaying these guidelines are available in the Information Folder stored on all Crash Trolleys within the Acute setting. The full Resuscitation Council (UK) guidelines and treatment algorithms can be accessed from their website at: www.resus.org.uk 4.3 The ECNHST Employment Services retain electronic records of all staff that attend for resuscitation training. 4.4 All Ward Senior Sisters/Department Managers are required to monitor attendance for resuscitation training events for those staff within their area of responsibility. 5.0 Process for Ensuring the Continual Availability of Resuscitation Equipment 5.1 Equipment for cardiopulmonary resuscitation will be of a minimum standard. 5.2 Within the Acute setting resuscitation trolleys for adult resuscitation should be stocked in accordance with the standardised list issued by the Resuscitation Committee, see appendix 3 for details. 5.3 Within the Acute setting, on the Paediatric Unit and other areas where children are treated, equipment and resuscitation drugs suitable for the resuscitation of paediatric patients will be available on a dedicated trolley. Such equipment will be chosen by those responsible for paediatric services following consultation with the Resuscitation Committee. 5.4 Within the Acute setting, portable oxygen and suction devices are available in all Wards and Departments. Where piped or wall oxygen/suction are available, these should always be used in preference. 5.5 Resuscitation equipment will be disposable so far as is reasonably practical. 5.6 Disposable items must be replenished at the earliest opportunity. For information relating to stock replenishment please refer to appendix 4, which provides a list of order codes and/or supplier information for adult resuscitation equipment. 5.7 Non-disposable items must be de-contaminated/cleaned in accordance with the manufactures recommendations and re-instated to the trolley as soon as is reasonably practical. 5.8 All resuscitation trolleys must be maintained in a state of readiness for use at all times. 5.9 It is the responsibility of the Ward Senior Sister/Department Manager to ensure that resuscitation equipment is checked daily and immediately following conclusion of a resuscitation event; when required equipment must be replenished as soon as is reasonably practical. The daily check includes checking all the items stored on top of the resuscitation trolley (including the defibrillator) and also checking that the tamper seal is in place and is intact. The unique identification number of the tamper seal must be recorded on the checklist on a daily basis. Once a week, the entire contents of the resuscitation trolley must be checked and a new tamper seal must be applied. The checking process must be recorded, dated and signed to indicate that the checks have been undertaken and that equipment is thereby readily available and is fit for use. 5.10 It is the responsibility of the Ward Senior Sister/Department Manager to ensure that drugs used for resuscitation, i.e. the Emergency Drug Boxes, are replaced after use and are checked 9

weekly and replenished as required. The task of replacing these must be undertaken immediately, so far as is reasonably practical, from Pharmacy during opening hours, or from the Reserve Drug Cupboard outside of Pharmacy hours. 5.11 The ECNHST Pharmacy Department is responsible for the drugs in the sealed Emergency Drug Boxes. Please refer to appendix 5 for a list of the drugs contained within the Adult Red Emergency Drug Boxes. 5.12 The drug Alteplase (rt-pa, tissue-type plasminogen activator) is available and licensed for use for the treatment of a cardiopulmonary arrest due to Pulmonary Embolus. Should the lead clinician at an arrest within the Acute setting deem the administration of this drug necessary, the drug is stored in the Intensive Care Unit, in the Coronary Care Unit and the Reserve Drug Cupboard for this use. 5.13 For all patients (excluding neonates) requiring tracheal intubation waveform capnography must be used to confirm and continually monitor tracheal tube placement. For areas where such equipment is not readily available the transfer monitor must be collected (from main Theatre) to enable this facility. 5.14 The Resuscitation Officer will conduct periodic audit of Resuscitation Trolley contents. 6.0 Procurement 6.1 The procurement of resuscitation equipment is subject to the ECNHST purchase requisition procedure. 7.0 Defibrillation 7.1 As early defibrillation is the single most important determining factor in survival from ventricular fibrillation, the widespread availability of defibrillators on resuscitation trolleys within the Acute setting is in place. All of the defibrillators have the capacity to be used as an automated external defibrillator (AED). 7.2 The Philips XL Heartstream/Heartstart defibrillators must be put through a user test once every 24 hours, see appendix 6 for details of this procedure. Following completion of the daily test the TEST LOAD must be removed from the patient connect cable ; please store the TEST LOAD safely behind the defibrillator in readiness for the next daily test. 7.3 If during a daily check the defibrillator is found not to be functional, the Medical Engineering Department (ext 1930) should be informed immediately. 7.4 Manual defibrillators will include the option of paediatric paddles and/or paediatric electrodes for defibrillation in areas where paediatric patients are treated. 7.5 Defibrillators with an external pacing facility are located strategically throughout the Acute setting, i.e. within Intensive Care Unit, Coronary Care Unit, Cardio-respiratory Department, Medical Assessment Unit, Emergency Department and Main Theatre Recovery (please note: this is subject to change). 7.6 A defibrillator must only be operated by persons specifically trained in their use. 10

8.0 Manual Handling 8.1 In situations where the collapsed patient is on the floor, in a chair or in a restricted/confined space the ECNHST Manual Handling Policy must be followed to minimise the risks of manual handling related injuries to both staff and the patient, (for the current version of this Policy see under M of the Policies section of the Trust Infonet). 8.2 Please also refer to the Resuscitation Council (UK) advisory document Guidance for safer handling during CPR in healthcare settings, which can be found at www.resus.org.uk 9.0 Cross Infection 9.1 Whilst the risk of infection transmission from patient to rescuer during mouth-to-mouth resuscitation is extremely rare, isolated cases have been reported. It is therefore advisable that direct mouth-to-mouth resuscitation be avoided in the following circumstances: All patients who are known to have or suspected of having an infectious disease; All undiagnosed patients entering the Emergency Department, Outpatients or other admission source; Other persons where the medical history is unknown. 9.2 To minimise the need for mouth-to-mouth ventilation all clinical areas should have immediate access to ventilation devices (e.g. a pocket mask). However, in situations where airway protective devices are not immediately available, start chest compressions, then if there are no contraindications consider giving mouth-to-mouth ventilations, if you are unwilling to or mouth-to-mouth ventilations are not appropriate, continue with continuous chest compressions until a ventilation device is available (Resuscitation Council (UK) 2015). 10.0 Anaphylaxis 10.1 The management of suspected anaphylaxis/anaphylactoid reactions should be conducted in accordance with the Resuscitation Council (UK) Guidelines for the Management of Anaphylaxis, which can found at www.resus.org.uk 11.0 Prevention of Cardiac Arrest the deteriorating patient 11.1 Within the Acute setting: 11.1.1 A National early warning scoring system known as NEWS is used to identify patients at risk of potential cardiopulmonary arrest. For full details of the NEWS system, please refer to the ECNHST VitalPAC Operational Policy and the Minimum Standards for Monitoring and Recording Adult in-patient Physiological Vital Signs, (for the current version of both of these documents see under V of the Policies section of the Trust Infonet). 11.1.2 The aim of the NEWS system is to promote early recognition of the deteriorating patient, enable delivery of prompt treatment and establish a plan for the parent team to provide further treatment. 11.1.3 The NEWS system is used for all adult in-patients within the Acute setting and is commenced on admission and used throughout the duration of the patient s hospital episode. 11.2 Within the Community setting: 11.2.1 When clinical staff recognise significant deterioration in a patient s clinical condition they must record those vital signs which it is practical to do so, whilst simultaneously initiating any appropriate treatment, and seeking further help. 11

11.2.2 In the event of a doctor being readily available to review the patient it is expected review will take place without delay; when this is not possible a request for an Ambulance must be made by dialling 999. 12.0 Decisions Relating to Cardiopulmonary Resuscitation 12.1 It is essential to identify patients for whom cardiopulmonary arrest represents an appropriate terminal event and in whom cardiopulmonary resuscitation is inappropriate. The ECNHST Unified Do Not Attempt Cardiopulmonary Resuscitation (udnacpr) Adult Policy, applicable for patients aged 18 years and over, will be utilised where appropriate, or the ECNHST Paediatric Do Not Attempt Cardiopulmonary Resuscitation Policy, applicable for patients under 18 years of age, (for the current version of both of these Policies see under R of the Policies section of the Trust Infonet - under the heading of Resuscitation ). 13.0 Patient Transfer and Post Resuscitation Care 13.1 Within the Acute Setting: 13.1.1 The immediate post resuscitation phase is characterised by high dependency and clinical instability. Most patients require either coronary care or intensive care treatment. Facilities for ongoing care of the patient may not be available at the location of the cardiopulmonary arrest and transfer of the patient may be necessary. Therefore, when appropriate, referral to specialists (e.g. Cardiologist or Intensivist) will be made. 13.1.2 It will be the responsibility of the Resuscitation Team Leader at the resuscitation event to ensure that the transfer of care from one group of clinicians to another is both appropriate and efficient. The Team Leader will not leave the patient until this has occurred unless he/she has delegated care to another appropriate colleague. 13.1.3 The patient s condition should be stabilised as far as possible prior to transfer, but this should not delay definitive treatment. Careful coordination is required to ensure that no delays occur. The nurse present should do this in conjunction with the doctor responsible for clinical care. 13.1.4 Ensure the patient can be monitored and treated in transit should their condition warrant it; equipment for transfer, including emergency drugs, portable oxygen and ECG monitoring/defibrillator should therefore be obtained prior to transferring the patient. NB: For all those patients (excluding neonates) who require tracheal intubation the transfer monitor must have the facility to monitor waveform capnography. 13.1.5 Staff with appropriate skills, i.e. an Anaesthetist/doctor and an appropriately trained nurse or Operating Department Practitioner, should transfer the patient and ensure the receiving unit receives a full handover and relevant patient documentation. 13.1.6 Relatives should be informed of the transfer of the patient. 13.2 Within the Community Setting: 13.2.1 The staff involved in the cardiopulmonary resuscitation event must provide information to the Emergency Services to ensure continuity of care; this will involve the following steps: Liaison with the Ambulance Services Full and complete hand-over of care to the Ambulance Crew Informing relatives 12

14.0 Implementation and Access to this Policy 14.1 This policy will be approved by the Resuscitation Committee and ratified by the Risk Management Sub-committee. 14.2 All Ward Senior Sisters/Department Managers/Service Line Managers will be sent a copy of this policy and must ensure that relevant staff have access to the policy and are appropriately trained in its implementation. 14.3 This policy will be published on the ECNHST Infonet within the Policies Section under the heading Resuscitation. Access to this document will be open to all ECNHST staff. 15.0 Measuring Performance and Audit Completion 15.1 Key performance indicators (KPI s) related to this policy are as follows: Outcome from cardiopulmonary arrest within Macclesfield District General Hospital will be audited on an annual basis. Audit results will be distributed accordingly as per the recommendation of the Resuscitation Committee The Resuscitation Officer will monitor the number of cardiac arrest calls per month to look for evidence of trends; any concerns will be reported to the Resuscitation Committee Compliance with the ECNHST Unified Do Not Attempt Cardiopulmonary Resuscitation Adult Policy will be audited by the Resuscitation Officer on an annual basis and reported to the Resuscitation Committee Compliance with the ECNHST Paediatric Do Not Attempt Cardiopulmonary Resuscitation Policy will be audited by the Resuscitation Officer on an annual basis and reported to the Resuscitation Committee The equipment stored within the resuscitation trolleys throughout the Trust will be audited on an annual basis by the Resuscitation Officer to ensure that equipment is checked daily, stocked appropriately and is fit for use. Audit results will be distributed accordingly as per the recommendations of the Resuscitation Committee The Resuscitation Committee will receive an annual report on training figures. Where deficiencies are identified action plans will be developed and implemented accordingly 15.2 This policy will be audited in line with the KPI s identified above on an annual basis by the Resuscitation Officer and reported to the Resuscitation Committee. 16.0 Cardiopulmonary Policy Review 16.1 This policy will be reviewed every 3 years by the Resuscitation Committee or more often if guidance changes. 17.0 Equality and Diversity 17.1 This policy has been impact assessed with regards to equality and diversity and there are no areas in the policy that contravene equality and diversity guidance (see appendix 7). 18.0 References Emergency Treatment of Anaphylactic Reactions. Resuscitation Council (UK) 2008. At http://www.resus.org.uk/pages/reaction.pdf (accessed 27/05/16) 13

Guidance for safer handling during CPR in healthcare settings. Resuscitation Council (UK) 2015. At http://www.resus.org.uk/pages/guide.htm (accessed 27/05/16) Quality standards for cardiopulmonary resuscitation practice and training. Resuscitation Council (UK) 2013. At http://www.resus.org.uk/pages/guide.htm (accessed 27/05/16) Resuscitation Council (UK) Resuscitation Guidelines 2015. At http://www.resus.org.uk/pages/guide.htm (accessed 27/05/16) Witnessing Resuscitation, Guidance for Nursing Staff. Royal College of Nursing, 2002. At http://www2.rcn.org.uk/ data/assets/pdf_file/0006/78531/001736.pdf (accessed 27/05/16) 14

Appendix 1 Cardiac Arrest Team Activity Proforma (V6.0/June 2016) To be completed by the Senior Nurse of the Arrest Team following ALL 2222 CALLS Complete all relevant sections of form & post immediately to: Resuscitation Officer, Service Corridor, MDGH Hospital No: Events leading to 2222 call: Date of Birth: / / Gender: Male Female Date of Admission: / / Ward/Area: Last 3 National Early Warning Scores: Score: Date: / / Time: / Score: Date: / / Time: / Score: Date: / / Time: / EVENT DETAILS: (NB: If peri-arrest, still complete relevant sections) Date: / / Witnessed Arrest? Y N Time: / Time of 2222 Call: / Resuscitation Attempted? Y N udnacpr Order in Place Type of Arrest: Respiratory Cardiac: VF/VT PEA/ASYSTOLE Time Team Arrived (1 st person): / Time of 1 st Shock: / Number of Shocks Delivered: Time ROSC* Achieved: / (*Return of spontaneous circulation) Drugs Used: Adrenaline Y N Total Number of Doses Given: Other Drugs: TEAM LEADER: OTHER ATTENDERS: 1. 2. 3. 4. 5. 6. 7. 8. Outcome Summary: If ROSC achieved has a management plan been documented? Yes No Debrief conducted post event? Yes No In your opinion should the patient have had a udnacpr decision made prior to the arrest? Yes No Unable to answer Comments e.g. any other relevant information / issues or concerns? (NB: If required, use other side too) Form Completed By: Name (PRINT): Signature: Date: 15

TIME CYCLE RHYTHM ALS MANAGEMENT E.G.: DEFIBRILLATION / DRUGS / OTHER (Please specify all which apply) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 NB: If applicable, details for any further cycles can be added to a separate A4 size sheet of paper. Additional Comments e.g. any other relevant information / issues or concerns? 16

Appendix 2 Cardiac Arrest Team Members 2003 REGISTRAR MEDICINE 2002 SHO MEDICINE 2000 HO MEDICINE 9000 SHO ANAESTHETICS 3405 MEDICAL NURSE PRACTITIONER (WHEN AVAILABLE) 7601 CHARGEHAND PORTER 3068 HEAD PORTER 3011 BED MANAGER/NIGHT SISTER 9999 RESUSCITATION OFFICER (WHEN AVAILABLE) PAEDIATRIC ARREST 9001 REGISTRAR ANAESTHETICS 3494 PAEDIATRIC REGISTRAR 2008 PAEDIATRIC SHO 9999 RESUSCITATION OFFICER (WHEN AVAILABLE) 7601 CHARGEHAND PORTER 3011 BED MANAGER/NIGHT SISTER 3405 MEDICAL NURSE PRACTITIONER (WHEN AVAILABLE) 3357 OPERATING DEPARTMENT PRACTITIONER (WHEN AVAILABLE) NEONATAL ARREST 5096 NEONATAL MIDDLE GRADE DOCTOR OR ADVANCED NNP 5083 NEONATAL SHO 17

Appendix 3 Page 1 of 2 CHECKLIST FOR ADULT RESUSCITATION EQUIPMENT Reviewed July 2016 CHECKING REQUIREMENT: CHECK TOP OF TROLLEY/DEFIBRILLATOR/TAMPER SEAL DAILY AND FULL TROLLEY WEEKLY WK COMM: WK COMM: CRASH TROLLEY CONTENTS M T W T F S S M T W T F S S TOP OF TROLLEY 1 x Defibrillator (with Test Load left unattached) 1 x Clock (i.e. time displayed on defibrillator screen) &/or stopwatch 3 x Packets of Defibrillator Pads 1 x Bag of ECG Electrodes 1 x Full 02 Cylinder with Regulator 1 x Stethoscope (on IV Pole) 1 x Intubation Bougie (on IV Pole) 1 x Self-Inflating Bag-Valve-Mask (B-V-M) (on IV Pole) 1 x Pocket Mask with 1 metre length of Oxygen Tubing 2 x Boxes of Gloves (1 Medium, 1 Large) Small Roll of Aprons 1 x Sharps Bin 1 x Clip Board with Cardiac Arrest Team Audit Forms TOP DRAWER (AIRWAY & BREATHING) 1 x Face Mask with Non-Rebreathe Bag Spare Face Masks for B-V-M (Size 3, 4, one of each) Guedel Airways (Sizes 1, 2, 3, 4, one of each) Nasopharyngeal Airways (Sizes 6, 7, one of each) Laryngeal Mask Airways (Sizes 3, 4, 5, one of each) Luer-Lock Syringes (Sizes 20ml, 50ml, one of each) 1 x Catheter Mount with 15mm Angled Connector (Sterile) 1 x Tracheal Tube Introducer (Stylet) (Size Medium) Cuffed ET Tubes (Sizes 6, 7, 8, one of each) 2 x Laryngoscope Handles (NB: These are reusable) Laryngoscope Blades (Size 3, 4, one of each) (Disposable) ((((Disposable) 2 x Spare Batteries for Laryngoscope Handles (Size AA) 1 x End-Tidal Carbon Dioxide (CO2) Detector 1 x Roll 12mm Cotton Tape 5 x Lubricating Jelly Sachets 1 x Adult Magill Forceps Eye Protection (i.e. one pair of Goggles) 1 x Pair of Large Cutting Shears (i.e. Tough Cut Scissors) 1 x Pen Torch MIDDLE DRAWER (CIRCULATION) 10 x 10ml Syringes 10 x 10ml 0.9% Sodium Chloride Ampoules 5 x 2ml Syringes 3 x 20ml Syringes Hypodermic Needles (21G Green, 23G Blue, five of each) Blood Bottles (Blue, Gold, Grey, Purple, Pink, two of each) 5 x Luer-Lock Cannula Stoppers 10 x Skin Wipes 2 x Arterial Cannula 3 x Arterial Blood Gas Syringes 2 x 3-way Tap Fixing Tape 1 x Box Disposable Tourniquets 5 x Packs of Gauze Swabs 5 x IV Dressings 3 x Disposable Razors 1 x Scalpel Checklist continued overleaf 18

Checklist continued from previous page Page 2 of 2 CHECKLIST FOR ADULT RESUSCITATION EQUIPMENT Reviewed July 2016 BOTTOM DRAWER (IV ACCESS) 2 x 1000ml 0.9% Sodium Chloride 1 x 500ml Gelofusine 1 x 500ml 10% Glucose 3 x IV Giving Sets 2 x Size 22G Cannula (Blue) 2 x Size 20G Cannula (Pink) 2 x Size 18G Cannula (Green) 2 x Size 16G Cannula (Grey) 1 x Bag of Tamper Seals BOTTOM OF TROLLEY Suction Machine (Set up ready for immediate use) 2 x Yankauer Sucker Suction Catheters (Sizes 12, 14, two of each) 1 x Suction Connecting Tube 1 x Adult Resuscitation Drug Box 1 x Emergency Handling Pack Small Roll Waste Bags (Size Medium) Crash Trolley Information Folder Trolley plugged into mains electric power supply and the defibrillator AC Power/Battery Charge lights are active: Trolley Clean and Tidy: M T W T F S S M T W T F S S Comments: (If applicable) Tamper Seal Intact: (Please record the identification number of seal daily) Daily (and/or weekly) check completed by: (Please enter initials and signature) CHECK TOP OF TROLLEY, DEFIBRILLATOR AND THAT TAMPER SEAL IS INTACT ON A DAILY BASIS. CHECK ENTIRE CONTENTS OF TROLLEY ON A WEEKLY BASIS, AND AFTER EACH USE, AND ALWAYS ENSURE A NEW TAMPER SEAL IS APPLIED. ALWAYS ENSURE THAT EQUIPMENT AND DRUG BOX EXPIRY DATES ARE IN DATE. 19

Appendix 4 Order Codes for MDGH Checklist for Adult Resuscitation Equipment Updated July 2016 ITEM ORDER CODE SUPPLIER APP. COST QUANTITY REMARKS TOP OF TROLLEY Defibrillator (Defib) Contact Medical Engineering Department for advice SBS Order Cardiac Services Medical Engineering telephone extension 1931 Paper Rolls for Defib FDI259 NHS Supply Chain 7.41 Box of 10 Defibrillation Pads FDJ162 NHS Supply Chain 11.33 Per Pack Do not open prior to use E.C.G. Electrodes FDK246 NHS Supply Chain 1.58 Pack of 30 Single use item Oxygen Cylinder Porters Contact Porters on Bleep 7601 Stethoscope FFE517 NHS Supply Chain 0.98 Each Intubation Bougie FTH040 NHS Supply Chain 53.23 Pack of 10 Do not bend. Single use item Bag-Valve-Mask FDE378 NHS Supply Chain Obtain from Main Theatre 5.03 Each Single use item. Theatres will supply this item Pocket Mask FDD1672 NHS Supply Chain 1.74 Each Single use item Oxygen Tubing FDG936 NHS Supply Chain 7.43 Each Box Ensure one metre in length Gloves: Medium/Large FTG286/FTG287 NHS Supply Chain 1.62 Box of 100 Single use item Aprons BTB272 NHS Supply Chain 4.94 Roll of 200 Single use item Sharps Bin (2.5 Litre) FSL182 NHS Supply Chain 0.73 Each Do not overfill sharps bin! Clip Board (with hook) WYL 2241 Office Depot UK LTD 4.41 Each AIRWAY/BREATHING Face Mask with Nonrebreathe Bag FDD321 NHS Supply Chain 0.65 Each Single use item Face Masks Sizes 3/4 FDD387/FDD388 NHS Supply Chain Obtain from Main Theatre 0.73 Each Single use item. Theatres will supply this item Guedel Airways FDB314/FDB316/ NHS Supply Chain 1.88 Pack of 10 Single use item Sizes 1/2/3/4 FDB317/FDB318 Nasopharyngeal FDB216/FDB218 NHS Supply Chain 9.09 Box of 10 Single use item Airways Sizes 6/7 Laryngeal Mask Airways Sizes 3/4/5 FDD520/FDD521/FDD522 NHS Supply Chain Obtain from Main Theatre 44.44 Box of 20 Single use item. Theatres will supply this item 50ml Syringe FWC408 NHS Supply Chain 18.10 Box of 60 Single use item 20ml Syringe FWC349 NHS Supply Chain 3.08 Box of 50 Single use item Catheter Mount with Filter FTC212 NHS Supply Chain Obtain from Main Theatre 50.67 Box of 40 Single use item. Theatres will supply this item Tracheal Tube Introducer (Stylet) FDF1113 NHS Supply Chain 11.87 Box of 20 Single use item

ITEM ORDER CODE SUPPLIER APP. COST QUANTITY REMARKS E.T. Tube Sizes 6/7/8 FDF574/FDF500/FDF502 NHS Supply Chain Obtain from Main Theatre 1.13 Each Single use item. Theatres will supply this item Laryngoscope Handle 4558GSP (green light standard) GE Healthcare 73.00 Each Re-usable handle Lary Blades Sizes 3/4 FSM1446/FSM1448 NHS Supply Chain 53.33 Box of 20 Single use item CO2 Detector MM1055370 Inspiration Healthcare 134.00 Box of 20 Single use item ½ Cotton Tape VWR045 NHS Supply Chain 3.32 Per Roll Single use item Lubricating Jelly FTM098 NHS Supply Chain 10.29 Pack of 100 Sachets Adult Magill Forceps FSM738 NHS Supply Chain 23.37 Box of 10 Single use item Goggles ILH406 NHS Supply Chain 4.86 Each Eye Protection Wear Tough Cut Scissors FIC8823 NHS Supply Chain 6.67 Pack of 10 Single use item Pen Torch FFE309 NHS Supply Chain 6.58 Pack of 10 Re-usable CIRCULATION All Drugs Pharmacy Syringes: FWC000/FWC128/FWC349 NHS Supply Chain Variable Variable Single use item 2ml/10ml/20ml Hypodermic Needles: 21G/23G FTR615/FTR052 NHS Supply Chain 21G = 2.16 23G = 1.72 Box of 100 Box of 100 Single use item Single use item Blood Bottles Pathology/Sub-Lab Luer-Lock Stoppers FVD116 NHS Supply Chain 4.24 Pack of 100 Single use item Skin Wipes VJT120 NHS Supply Chain 3.24 Pack of 200 Single use item Arterial Cannula FSP857 NHS Supply Chain 1.83 Each Single use item A.B.G. Syringes FWC455 NHS Supply Chain 0.93 Each Single use item 3-way Tap FVK004 NHS Supply Chain 0.30 Each Single use item Tourniquet FWJ013 NHS Supply Chain 1.98 Pack of 25 Re-usable Gauze Swabs Size 7.5 cm by 7.5 cm HSDU Single use item I.V. Dressings ELW046 NHS Supply Chain 34.46 Pack of 100 Single use item I.V. Giving Sets FSB631 NHS Supply Chain 0.53 Each Single use item Cannula: FSN368/FSN369/ NHS Supply Chain 0.59 Each Single use item Pink/Blue/Green/Grey FSN367/FSN364 Disposable Razors MRA170 NHS Supply Chain 2.92 Pack of 25 Single use item Scalpel Size 10 FGP467 NHS Supply Chain 2.29 Box of 10 Single use item SUCTION UNIT Suction Machine Contact Medical Engineering SBS Order Medical Engineering x 1931 Yankauer Sucker FWP084 NHS Supply Chain 0.28 Each Single use item Flexible Suction Catheter, Sizes 12/14 FSQ303 FSQ304 NHS Supply Chain NHS Supply Chain 0.18 0.18 Each Each Single use item Single use item Suction Connecting Tube FWP173 NHS Supply Chain 0.63 Each Single use item

Appendix 5 List of Drugs Contained within the Adult Red Emergency Drug Boxes Adrenaline 1:10,000 1mg/10ml pre-filled syringe x 8 Amiodarone 300mg/10ml pre-filled syringe x 2 Adenosine 6mg/2ml ampoules x 6 Atropine 1mg/5ml pre-filled syringe x 1 Magnesium Sulphate 5g/10ml ampoule x 1 Sodium Bicarbonate 8.4% 10mmol/10ml ampoules x 5 Calcium Chloride 10% (10ml) pre-filled syringe x 2 Naloxone 2mg/2ml pre-filled syringe x 1 Adrenaline 1:1000 1mg/1ml ampoules x 2 Chlorphenamine 10mg/1ml ampoules x 2 Hydrocortisone 100mg/1ml ampoules x 5 22

Appendix 6 Instructions for the Daily Check of the Philips XL Heartstream/Heartstart Defibrillator Please follow the steps below: 1. Ensure the defibrillator is switched off at Dial 1 and unplugged at the mains supply 2. Attach the TEST LOAD device to the defibrillator (i.e. to the end of the Black Cable plugged into the front bottom left hand corner of the XL defibrillator) 3. Press and Hold the Strip Button, turn the energy select knob (i.e. Dial 1) to Manual On at the same time. Once the display screen is showing prompts release the Strip Button 4. Conduct the test by following the verbal and displayed prompts as they are given. NB: This will include pressing Button 2 (to charge the defibrillator) then pressing Button 3 (to deliver the shock) it is perfectly safe to undertake this procedure due to the fact the TEST LOAD device is attached to the defibrillator Once the Test is complete: 1. Turn the XL Defibrillator off 2. Disconnect the TEST LOAD device from the Black Cable and store it behind the defibrillator 3. Ensure you plug the Defibrillator back into the mains supply and check that the AC Power and Battery Charge light are illuminated 4. Review and sign the printed test report (please retain these reports for a period of one month, after this time please discard) Cardiopulmonary Resuscitation Policy V 7.0 23

Appendix 7 Equality Analysis (Impact assessment) 1. What is being assessed? Cardiopulmonary Resuscitation Policy Details of person responsible for completing the assessment: Name: Jackie Cornes Position: Resuscitation Officer Team/service: Medical Specialty State main purpose or aim of the policy, procedure, proposal, strategy or service: (usually the first paragraph of what you are writing. Also include details of legislation, guidance, regulations etc which have shaped or informed the document) East Cheshire NHS Trust has a duty of care to provide an effective resuscitation service for patients who suffer cardiopulmonary arrest. To achieve this standard all relevant staff will be trained appropriately and regularly updated to a level compatible with their expected degree of competence. The purpose of this policy is to provide direction and guidance for the planning and implementation of a high-quality and robust resuscitation service to the organisation. The strategy for resuscitation incorporates the current Resuscitation Council (UK) guidelines. This policy fully supports the recommendations for quality standards for cardiopulmonary resuscitation practice and training published by the Resuscitation Council (UK) (2013). 2. Consideration of Data and Research To carry out the equality analysis you will need to consider information about the people who use the service and the staff that provide it. 2.1 Give details of RELEVANT information available that gives you an understanding of who will be affected by this document Cheshire East (CE) covers Eastern Cheshire CCG and South Cheshire CCG. Cheshire West & Chester (CWAC) covers Vale Royal CCG and Cheshire West CCG. In 2011, 370,100 people resided in CE and 329,608 people resided in CWAC. Age: East Cheshire and South Cheshire CCG s serve a predominantly older population than the national average, with 19.3% aged over 65 (71,400 people) and 2.6% aged over 85 (9,700 people). Vale Royal CCGs registered population in general has a younger age profile compared to the CWAC average, with 14% aged over 65 (14,561 people) and 2% aged over 85 (2,111 people). Since the 2001 census the number of over 65s has increased by 26% compared with 20% nationally. The number of over 85s has increased by 35% compared with 24% nationally. 24

Race: In 2011, 93.6% of CE residents, and 94.7% of CWAC residents were White British 5.1% of CE residents, and 4.9% of CWAC residents were born outside the UK Poland and India being the most common 3% of CE households have members for whom English is not the main language (11,103 people) and 1.2% of CWAC households have no people for whom English is their main language. Gypsies & travellers estimated 18,600 in England in 2011. Gender: In 2011, c. 49% of the population in both CE and CWAC were male and 51% female. For CE, the assumption from national figures is that 20 per 100,000 are likely to be transgender and for CWAC 1,500 transgender people will be living in the CWAC area. Disability: In 2011, 7.9% of the population in CE and 8.7% in CWAC had a long term health problem or disability In CE, there are c.4500 people aged 65+ with dementia, and c.1430 aged 65+ with dementia in CWAC. 1 in 20 people over 65 has a form of dementia Over 10 million (c. 1 in 6) people in the UK have a degree of hearing impairment or deafness. C. 2 million people in the UK have visual impairment, of these around 365,000 are registered as blind or partially sighted. In CE, it is estimated that around 7000 people have learning disabilities and 6500 people in CWAC. Mental health 1 in 4 will have mental health problems at some time in their lives. Sexual Orientation: CE - In 2011, the lesbian, gay, bisexual and transgender (LGBT) population in CE was estimated at18,700, based on assumptions that 5-7% of the population are likely to be lesbian, gay or bisexual and 20 per 100,000 are likely to be transgender (The Lesbian & Gay Foundation). CWAC - In 2011, the LGBT population in CWAC is unknown, but in 2010 there were c. 20,000 LGB people in the area and as many as 1,500 transgender people residing in CWAC. Religion/Belief: The proportion of CE people classing themselves as Christian has fallen from 80.3% in 2001 to 68.9% In 2011 and in CWAC a similar picture from 80.7% to 70.1%, the proportion saying they had no religion doubled in both areas from around 11%-22%. Christian: 68.9% of Cheshire East and 70.1% of Cheshire West & Chester Sikh: 0.07% of Cheshire East and 0.1% of Cheshire West & Chester Buddhist: 0.24% of Cheshire East and 0.2% of Cheshire West & Chester Hindu: 0.36% of Cheshire East and 0.2% of Cheshire West & Chester Jewish: 0.16% of Cheshire East and 0.1% of Cheshire West & Chester Muslim: 0.66% of Cheshire East and 0.5% of Cheshire West & Chester Other: 0.29% of Cheshire East and 0.3% of Cheshire West & Chester None: 22.69%of Cheshire East and 22.0% of Cheshire West & Chester Not stated: 6.66% of Cheshire East and 6.5% of Cheshire West & Chester Carers: In 2011, nearly 11% (40,000) of the population in CE are unpaid carers and just over 11% (37,000) of the population in CWAC. 2.2 Evidence of complaints on grounds of discrimination: (Are there any complaints or concerns raised either from patients or staff (grievance) relating to the policy, procedure, proposal, strategy or service or its effects on different groups?) No 25